What is the appropriate Omnicef (cefdinir) dose for a 10.4 kg pediatric patient?

Omnicef (Cefdinir) Dosing for 10.4 kg Pediatric Patient

For a 10.4 kg pediatric patient, administer cefdinir 7 mg/kg every 12 hours (approximately 73 mg twice daily) or 14 mg/kg once daily (approximately 146 mg once daily), depending on the indication. 1

Standard Dosing Regimen

The FDA-approved dosing for pediatric patients aged 6 months through 12 years is based on a total daily dose of 14 mg/kg, up to a maximum of 600 mg per day. 1 This can be administered as:

• 7 mg/kg every 12 hours (twice daily dosing)
• 14 mg/kg once daily (for most infections)

For your 10.4 kg patient, this translates to:

• 73 mg twice daily (7 mg/kg × 10.4 kg = 72.8 mg per dose)
• 146 mg once daily (14 mg/kg × 10.4 kg = 145.6 mg total daily dose)

Indication-Specific Dosing and Duration

Acute Bacterial Otitis Media

• 7 mg/kg every 12 hours for 5-10 days OR 14 mg/kg once daily for 10 days 1
• Once-daily dosing for 10 days has been shown to be as effective as twice-daily dosing 1

Acute Maxillary Sinusitis

• 7 mg/kg every 12 hours for 10 days OR 14 mg/kg once daily for 10 days 1

Pharyngitis/Tonsillitis

• 7 mg/kg every 12 hours for 5-10 days OR 14 mg/kg once daily for 10 days 1
• Clinical trials have demonstrated superior efficacy compared to penicillin V, with clinical cure rates of 94.9% versus 88.5% 2

Uncomplicated Skin and Skin Structure Infections

• 7 mg/kg every 12 hours for 10 days 1
• Important caveat: Once-daily dosing has NOT been studied for skin infections, so twice-daily administration is required for this indication 1

Practical Administration Using Oral Suspension

Using the 125 mg/5 mL concentration (most appropriate for this weight):

• For 73 mg per dose: Administer approximately 2.9 mL every 12 hours
• For 146 mg once daily: Administer approximately 5.8 mL once daily

The FDA dosage chart indicates that for patients weighing 9 kg (20 lbs), the dose is 2.5 mL of 125 mg/5 mL suspension every 12 hours or 5 mL once daily. 1 Your 10.4 kg patient falls slightly above this weight, so rounding to 2.5-3 mL twice daily or 5-6 mL once daily is appropriate.

Key Clinical Considerations

• Administration with food: Cefdinir may be given without regard to meals, though food may improve gastrointestinal tolerability 1
• Suspension stability: After mixing, store at room temperature (25°C/77°F) in a tightly closed container; shake well before each dose; discard after 10 days 1
• Renal function: No dose adjustment is needed for normal renal function; if creatinine clearance is <30 mL/min/1.73 m², reduce to 7 mg/kg once daily 1

Efficacy and Safety Profile

Cefdinir demonstrates excellent activity against common respiratory pathogens including Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis, with susceptibility rates of 97-99% against H. influenzae 3. The drug is stable against 13 common beta-lactamases, making it effective against beta-lactamase-producing strains 4, 5.

Common adverse effects: Diarrhea is the most frequently reported adverse event, though discontinuation rates are generally similar to comparator agents 4. The oral suspension has demonstrated superior taste and palatability compared to other oral antimicrobials 6.

Clinical Monitoring

• Expected response time: Clinical improvement should occur within 48-72 hours of starting therapy 7
• Treatment failure: If no improvement or worsening occurs after 48-72 hours, reassess the diagnosis and consider alternative pathogens or complications 7